Covers intradiscal electrothermal therapy (IDET) to treat spinal disc-related chronic low back pain. Explains why it is done and what to expect after surgery. Includes how well it works. Looks at possible risks.

Intradiscal Electrothermal Therapy (IDET) for Low Back Pain

Surgery Overview

Intradiscal electrothermal therapy (IDET) is a relatively new,
minimally invasive treatment for
spinal disc-related chronic
low back pain. This type of persistent disc pain is
thought to be caused by nerve fibers that have grown from their normal location
in the outer layers of the disc, reaching into the disc interior. This is related to the breakdown (degeneration) of the tough
outer layers (annulus) of the disc. The pain may also be from injury to the
disc, causing the material in the center (nucleus) of the disc to move into the
outer layers of the disc. This material from the nucleus is irritating to the
outer layers, where the nerves are, and it causes pain.

Discography is typically done before IDET to try to
clearly identify the disc problem. After discography, your doctor will decide
whether it is likely that your disc problem can be helped by IDET. Before an
IDET procedure, you are given a
sedative and a
local anesthetic. Using "live" X-ray imaging
(fluoroscopy), a doctor inserts a hollow needle containing a flexible tube
(catheter) and heating element into the spinal disc. The catheter is positioned
in a circle in the outer layer (annulus) of the disc and is then slowly heated
to about 194°F (90°C). The heat
is meant to destroy the nerve fibers and toughen the disc tissue, sealing any
small tears. Antibiotics, either given in a vein (intravenous) or
injected into the disc, are used to prevent a disc infection.

What To Expect After Surgery

Pain relief after IDET is not
immediate. Pain may increase during the first couple of days. Physical therapy
is a necessary part of recovery. During the first month after IDET, plan to
walk and do easy stretches as prescribed by your doctor. During the first 2 to
3 months, exercise as directed, and avoid lifting, bending, and long periods of
sitting.

People who have had IDET are usually told to wait at least 5 to 6
months before resuming strenuous sports such as skiing, running, or
tennis.1

Why It Is Done

IDET is used to treat a select
subgroup of people who have had chronic disc-related low back pain (usually for
at least 3 to 6 months) despite nonsurgical treatment.2, 3 IDET is not recommended for people
who have severe disc degeneration,
spinal stenosis, or spinal instability (such as
spondylolisthesis).

How Well It Works

Since its introduction in the 1990s, IDET has been evaluated in several small studies. Larger studies have
been hard to do, because most people do not meet the requirements for this
procedure. There is no consistent evidence that this treatment works, and most experts do not recommend it.4

Risks

Although complications are rare, possible risks include:

Nerve damage.

Disc
damage.

Disc infection.

Discography may increase the risk of disc problems in the future.5 If your doctor recommends
discography, experts recommend getting a
second opinion before having the test.

What To Think About

If you are considering IDET, be sure that you are a good candidate
for the procedure and that the doctor doing the procedure is well trained
and experienced. If you are unsure about whether IDET is right for you,
consider getting a
second opinion.

Here are some of the criteria your doctor will use to decide whether you might
be a good candidate for IDET.6

You may be a candidate
for IDET if:

You are probably not a
candidate for IDET if:

You have had disc-related pain for at least 6 months.

Your symptoms have not improved with at least 6
weeks of nonsurgical treatment, including pain medicine and physical therapy
or a home exercise program for low back pain.

Pain is mostly in the
low back, not in the leg.

Pain is worst when you are
sitting.

Discography shows damage inside the disc. The damage is at the back of the outer layer (annulus) of
the degenerated spinal disc.

You do not meet all the criteria to be
eligible for IDET (such as the criteria listed in the column to the
left).

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